HBV genotype C HBeAg seroconversion rate ‘negligible’
medwireNews: Patients with chronic hepatitis B virus (HBV) genotype C infection who are positive for hepatitis B e antigen (HBeAg) should not delay antiviral treatment in the hope of seroconversion, Korean researchers recommend.
Over 6 months, just one (1.1%) of 90 patients, all of whom had HBV DNA levels above 20,000 IU/mL and alanine aminotransferase (ALT) levels more than twice the upper limit of normal, showed both spontaneous loss of HBeAg and detection of anti-HBe, reports the team from Jeju National University School of Medicine.
The study protocol recommended antiviral treatment for all patients showing biochemical deterioration during follow-up; 18.9% of patients had entecavir or tenofovir treatment initiated on the development of acute exacerbations, aggravation of jaundice or both.
And a further five patients began immediate antiviral treatment after experiencing worsening symptoms without biochemical deterioration.
Biochemical deterioration was significantly and independently predicted by high HBV DNA levels and high ALT, say Byung-Cheol Song and co-authors in Clinical and Molecular Hepatology.
Indeed, 46.7% of the 15 patients who had HBV DNA above 5.1 x 107 IU/mL and ALT greater than five times the upper limit of normal experienced biochemical deterioration. One such patient developed acute-on-chronic liver failure and required transplantation despite entecavir therapy.
The team explains that high serum ALT is usually a marker for “vigorous” host immune response and HBV clearance, suggesting that “some abortive immune clearance mechanism might exist in patients infected with HBV genotype C”.
Finding biochemical deterioration to be “common” in this population, they recommend that “immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels.”
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